The long term objective of this research is to develop a clinically-enhanced administrative database that builds upon the foundation that has already been established in Minnesota by the Minnesota Hospital Association and to demonstrate its use in studying comparative effectiveness. Minnesota's administrative claims database already is enhanced by present-on- admission coding and the addition of laboratory data. This proposal will increase the number of hospitals submitting laboratory data, will expand the database to include inpatient pharmacy data, and will link patient data across hospitals and with Minnesota death certificates. The expanded dataset will support better measurement of risk-adjusted clinical outcomes and comparative effectiveness analyses of pharmaceutical interventions. A comparative effectiveness analysis of alternative drug regimens used to treat patients hospitalized with acute decompensated heart failure will be performed using the clinically-enhanced administrative hospital discharge database. The care and clinical outcomes of subgroups of high interest patients (e.g., elderly, women, high-risk patients) also will be evaluated. Because of the complexity of heart failure and the therapies used to manage it, this study will be an excellent test to ability of clinically-enhanced administrative databases to provide important information about comparative effectiveness in areas where randomized controlled clinical trials and prospectively designed clinical registries often fall short. PUBLIC HEALTH RELEVANCE: Establishing comprehensive "real life" databases for the evaluation of clinical effectiveness of current medical therapies is important to obtain information needed by healthcare professionals to provide the highest possible quality of care. This project builds on previous collaborations between the Minnesota Hospital Association and Michael Pine and Associates to add valuable laboratory data to Minnesota's hospital claims database without incurring the cost of expensive abstraction of medical records. This project will further enhance this database with hospital pharmacy data, link patient encounters across hospitals, and add information about out-of- hospitals deaths from Minnesota death certificates. The database will be used to conduct a study of the comparative effectiveness of different drug treatments of patients hospitalized with acute worsening of congestive heart failure.